Transpulmonary thermodilution techniques in the haemodynamically unstable patient

Abstract

Purpose of review Transpulmonary thermodilution (TPTD) devices invasively measure not only cardiac output but also several other haemodynamic variables estimating cardiac preload, cardiac preload, systolic function, the lung oedema and systolic function, the lung oedema and the pulmonary permeability. In light of the recent literature, we describe how different indices are measured, emphasize their clinical interest and list potential limits and side-effects of the technique. Recent findings Estimation of cardiac output measurement with TPTD is now well established, at least when compared with the pulmonary artery catheter. The advantage of calibrating the pulse contour analysis, as it is allowed by TPTD indices, is clearly established over uncalibrated devices. The greatest advantage of TPTD is to measure extravascular lung water and pulmonary permeability, which may be useful to diagnose acute respiratory distress syndrome and manage fluid therapy in various critical diseases. It also allows a rapid detection of left ventricular systolic failure. The information it provides must be considered complementary to that provided by echocardiography. Summary TPTD provides several indices that may help in making decisions during the therapeutic management of haemodynamically unstable patients. It should be used for the most critically ill patients, whose management requires a reliable, precise and holistic view of the cardiopulmonary condition.

COVID-19 ARDS is characterized by higher extravascular lung water than non-COVID-19 ARDS: the PiCCOVID study

“…In the COVID-19 group, patients were consecutively included, from the first day on which COVID-19 patients started to be admitted in each ICU to October 30. Inclusion criteria were: age ≥ 18 years, presence of ARDS [ 26 ], infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) confirmed by reverse transcriptase–polymerase chain reaction on a nasal swab or a tracheal aspiration, invasive mechanical ventilation, monitoring in place with transpulmonary thermodilution (PiCCO2, Pulsion Medical Systems, Feldkirchen, Germany) [ 27 ]. The exclusion criterion was the presence of an extracorporeal membrane oxygenation (ECMO) assistance at the time of inclusion, since ECMO impairs the reliability of transpulmonary thermodilution [ 15 ].…”

“…All patients were equipped with a thermistor-tipped arterial catheter introduced through the femoral artery and an internal jugular vein catheter [ 15 , 27 ]. The results obtained from three injections of cold saline boluses were averaged [ 28 ].…”

Zielgerichtetes hämodynamisches Monitoring im OP: Wozu und womit?

“…Die Steuerung der Katecholamine kann über die Global Ejection Fraction (GEF) und den systemisch vaskulären Widerstand erfolgen. Eine detaillierte Übersicht zu den Verfahren findet sich unter [51,52]. Im operativen Setting hat die Anwendung dieser Verfahren nur einen geringen Stellenwert.…”

The Importance of Extravascular Lung Water Measurement in Major Surgeries

“…Klinisyenler için, ekstravasküler akciğer sıvısının kesin ölçümünün yanı sıra hidrostatik basınç artışı veya permeabilite artışı gibi etiyolojilerin ayırt edilmesi de vazgeçilmezdir [6] . Majör cerrahilerde perioperatif ekstravasküler akciğer sıvısı (EVLW) ölçümü, pulmoner ödemin erken tanı ve tedavisinin takibi kadar ventilatörden ayırma (weaning), sıvı yönetimi ve farmakolojik müdahalelere yanıtın gözlenmesi gibi farklı amaçlara yönelik de kullanılmaktadır [7,8] .…”